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The Importance of Screening For Hypermobility

Updated: Oct 19, 2022

Written By: Brian Cunningham

In a previous article, I referred to the Jenga Effect for swimmers. The body is a tower that needs a strong stable foundation. Each segment of the body must be stacked correctly, under tension, in order to function. If one block or section is misaligned or loose, the entire tower is at risk of collapsing. If we apply this concept to the swimmer’s body, noting that if one side of the body is under constant pressure, it will habitually become the dominant firing position to activate the athlete's muscles. Just like the tower will need a solid ground in order to build the structure, the athlete's body needs structural integrity and awareness. Hypermobile athletes need to own and control their range.

Just like a fishing rod is strong, flexible and resistant to breaking, a hypermobile athlete's structure needs to be as pliable and strong as a fishing rod. Also, before we can drive a car, we have to understand the basics. With young swimmers, we, as coaches, have to teach about foundation (where their engines are), and how to put them into gear and drive. This is why activation and body awareness drills are crucial. They are necessary for all swimmers, but for those who are super flexible, hypermobile athletes in my experience it can be a game changer.

It is not all about strength and power but more about body awareness and control.


Mobility refers to the range of motion in a joint, and it is influenced by the surrounding soft tissue. The soft tissue is made up of skin, fascia, tendons, and ligaments (superficial to deep), as well as the nervous system and joint articulation (surfaces). Another key term to understand is flexibility, and this refers to soft tissue mobility.

Each joint has an optimal range, and when that optimal range is exceeded, hypermobility occurs. There are varying degrees of joint hypermobility and hypermobility can occur in one joint or in multiple joints. About 20% of the population has hypermobility in at least one joint. Typically, hypermobility develops over time and it can be due, in part, to overstretching. Hypermobility is commonly seen in such activities as dancing or gymnastics. A few key points regarding hypermobility include the following:

  • Generalized hypermobility can be asymptomatic.

  • It typically presents in more than 5 joints.

  • It can be either inherited or acquired.

  • It typically presents in girls more than boys.

Why Should We Screen for Hypermobility In Our Swimmers?

  1. To help coaches understand movement characteristics of their swimmers;

  2. To learn typical compensation patterns of swimmers with hypermobility;

  3. To properly correct common compensation patterns in hypermobile swimmers;

  4. To show hypermobile swimmers how to use their excessive movement as an advantage;

  5. To categorize athletes with similar movements and compensation patterns into similar training groups;

  6. To have a simple and effective way to screen potential athletes coming into our programs with an eye toward stability and strength.

How to Identify Hypermobility in Athletes

  • They stand in their end-range positions, have rounded shoulders, and their upper back and knees are locked.

  • They stretch to the extremes . . . and still complain about feeling tight.

  • They can do anything a coach asks–without warming up–and indicate it's easy; they also don't understand why others can't do what they're doing.

  • They hyper-streamline their arms behind their head with their pelvis jutted forward, and their knees hyper-extended, too. (bend backwards)

  • If we assess ankle flexibility by asking swimmers to get into a long sitting position, we'll notice that when we ask swimmers to point their toes forward, they will be able to touch the floor with their toes and their heels will stay on the floor.

  • If we ask our swimmers to put their arms out at 90 degrees, there should be a straight line. But if a swimmer's elbows are bent backwards, that swimmer is likely hypermobile in the elbow joint.

Typical Presentation

A physical therapist who specializes in swimmers and elite athletes can help a coach figure out if their athletes are hypermobile, but there are some tests coaches can run, too. The most common hypermobile indicator is the Beighton score, which uses a simple nine-point testing system. Generally a score of 4 or more indicates hypermobility.

Having hypermobile joints means the coach and swimmer have to be cautious with dryland activities. For example, hypermobility can add obstacles when swimmers are performing jumps and weights during dryland training. Since hypermobile swimmers tend to lack joint proprioception, and since they can struggle with body-spatial awareness, the potential for dryland injury should be on coaches' radars. Interestingly, studies have shown increased risk of injury to the knees and shoulders in athletes with joint hypermobility.

The Good . . . and The Bad . . . of Hypermobile Athletes

I have spent countless hours on deck watching supreme athletes like Michael Phelps, Tom Shields, and Rhyan White represent our country at the competitions such the Olympic games, but knowing that they fall into the category of hypermobility, I often scratch my head in amazement at how they perform so well. One thing I've observed is that these elite, hypermobile swimmers can swim fast because they have trained in perfect alignment and solidified their tower over years and years. Sadly, with the advent of Iphones and kids getting them earlier, as well the effects of the pandemic, I have seen a surge of weak and hypermobile athletes coming into my practice. They are a lot younger than what I'm used to and they also have more complaints than sore shoulders

Things Hypermobile Swimmers Should Avoid

Avoid stretching. A common complaint with hypermobile athletes is that they constantly feel tight, and the reason is because the muscles around the joints are creating tension in order to protect the underlying dysfunction of the ligaments and tendons (which are inherently lax). By stretching, the athlete is adding more stress to those already weak and vulnerable joints. Instead, add compression to the joint and surrounding muscles; swimmers can do this with a tennis ball or massage stick.

Avoid Becoming Overly Fatigued

When people are fatigued, their muscles are less able to stabilize. In this situation, an athlete can be at increased risk of injury, especially during dryland exercises. This is why I advocate for dryland before swimming. In my work with teams, I help teach athletes to recognize subtle signs of fatigue, and I also stress how athletes can be connected. That is, I teach athletes to move from a strong stable foundation. I also strongly recommend bodyweight exercises before adding any external loads.

Avoid End Ranges

During strengthening activities like pushups and pullups, hypermobile athletes should avoid locking the elbows. That will help prevent athletes from reaching into overextended positions, which put joints in unstable positions and makes muscles weaker. Swimmers need to demonstrate having control over their range of motion. Small, tight, and fast undulation during breakouts is a good example of swimmers having control over their range of motion.

Avoid Misleading Lingo

The common words given to swimmers, such as "stretch," "be tall," and "lengthen your stroke" can be misinterpreted by some hypermobile athletes. This is because hypermobile athletes often have poor joint and body awareness, as well as poor control over their movements. When hearing the cues "be tall," etc, hypermobile athletes can end up overextending themselves; this, inevitably, leads to decreased performance.

Remember: Everything is Connected

It's important to understand that everything is connected. Think of a tower or a chain, and concentrate on working from a connected posture (instead of focusing on joints that are hypermobile and weak). Build the foundation of great postural alignment with a strong stable core. Swim and move from the inside out and see how fast you go!


In the ideal world, every team would have a consultant like me to work with the athletes before they get injured. In reality hypermobility is more complex than simply helping reposition the segment. It is building a whole new foundation of stability, body awareness, joint range awareness, and control. My philosophy is to stay connected in order to swim smarter, faster and stronger.

I correct movement dysfunction and muscular imbalances to enhance swim performance

More specifically I . . .

  • Learn the swimmer's history, injury profile and performance goals.

  • Observe the swimmer's mobility and postural alignment.

  • Discover the swimmer's unique physiology through muscular palpation and fascia work.

  • Conduct neuromuscular assessment and retraining through facilitation and inhibition of the nervous system.

  • Develop customized exercises and strategies to help swimmers be more connected in and out of the water.

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